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. 2022 Jun:245:149-157.e1.
doi: 10.1016/j.jpeds.2022.01.049. Epub 2022 Feb 1.

US Postarrival Evaluation of Immigrant and Refugee Children with Latent Tuberculosis Infection Diagnosed Overseas, 2007-2019

Zanju Wang  1 , Drew L Posey  2 , Richard J Brostrom  3 , Sapna Bamrah Morris  3 , Nina Marano  2 , Christina R Phares  2
Affiliations

US Postarrival Evaluation of Immigrant and Refugee Children with Latent Tuberculosis Infection Diagnosed Overseas, 2007-2019

Zanju Wang et al. J Pediatr. 2022 Jun.

Abstract

Objective: To assess outcomes from the US postarrival evaluation of newly arrived immigrant and refugee children aged 2-14 years who were diagnosed with latent tuberculosis infection (LTBI) during a required overseas medical examination.

Study design: We compared overseas and US interferon-γ release assay (IGRA)/tuberculin skin test (TST) results and LTBI diagnosis; assessed postarrival LTBI treatment initiation and completion; and evaluated the impact of switching from TST to IGRA to detect Mycobacterium tuberculosis infection overseas.

Results: In total, 73 014 children were diagnosed with LTBI overseas and arrived in the US during 2007-2019. In the US, 45 939 (62.9%) completed, and 1985 (2.7%) initiated but did not complete a postarrival evaluation. Among these 47 924 children, 30 360 (63.4%) were retested for M tuberculosis infection. For 17 996 children with a positive overseas TST, 73.8% were negative when retested by IGRA. For 1051 children with a positive overseas IGRA, 58.0% were negative when retested by IGRA. Overall, among children who completed a postarrival evaluation, 18 544 (40.4%) were evaluated as having no evidence of TB infection, and 25 919 (56.4%) had their overseas LTBI diagnosis confirmed. Among the latter, 17 229 (66.5%) initiated and 9185 (35.4%) completed LTBI treatment.

Conclusions: Requiring IGRA testing overseas could more effectively identify children who will benefit from LTBI treatment. However, IGRA reversions may occur, highlighting the need for individualized assessment for risk of infection, progression, and poor outcome when making diagnostic and treatment decisions. Strategies are needed to increase the proportions receiving a postarrival evaluation and completing LTBI treatment.

Keywords: children; immigrant; interferon-γ release assay; latent tuberculosis infection; postarrival evaluation; refugee; retesting; reversion; tuberculin skin test.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure.
Figure.
A, Testing* for Mtb infection and outcomes of US postarrival evaluation of immigrant and refugee children aged 2–14 years who were diagnosed with LTBI during the overseas medical examination under 2007 TB TIs and under 2018 TB TIs (went into effect October 1, 2018) and arrived in the US during 2007–2019. *Chest radiograph, culture, or smear tests performed during the overseas medical examination and US postarrival evaluation were not shown. †Among children whose postarrival evaluation was completed or initiated but not completed, 29 726 (63.5%) were retested under 2007 TB TIs and 634 (55.5%) were retested under 2018 TB TIs. The overall number of children retested and percent of children whose postarrival evaluation was completed or initiated but not completed were 30 360 (63.4%). B, LTBI cascade of care for children aged 2–14 years whose overseas LTBI diagnosis was confirmed during their US postarrival evaluation, 2007–2019. For the concept of LTBI cascade of care, refer to the references.,
See this image and copyright information in PMC

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